Medical career choice: Current status of research literature

This article examines the research evidence supporting relationships between both personal and social factors and the career choices of physicians in training. Although the research literature in this area is limited by a lack of longitudinal studies, a dependence on cross‐sectional designs, and a lack of multivariate investigations, data support relationships in each of the following areas: sociodemographic characteristics of student, student personality and attitudinal variables, institutional characteristics of the medical school, characteristics of the specialty training programs, and information available to students about the various careers. Additionally, this review investigates the stability of career preferences and career choices over time.     

Factors influencing general practitioner referrals to a tertiary paediatric neurodisability service.

This study investigated factors influencing general practitioner (GP) referrals to a tertiary paediatric neurodisability service, including the reasons for referral, the children's characteristics, and the involvement of secondary specialist services in the referral. Fifty general practitioners (GPs) referring consecutively to the Neurodisability Service, Great Ormond Street Hospital for Children, London, were interviewed in a cross-sectional study using a postal questionnaire. The main findings were that two-thirds of the GPs did not contact secondary specialist providers prior to referring. The majority (78%) of GPs were responding to parental concerns in the context of a lack of medical diagnosis in 74% of the children. The main (90%) reason given for referral was for parents seeking a second opinion outside their district network. The findings highlighted the influence of parents over GPs' referrals to tertiary neurodisability, and, in light of this, raised issues for consideration for effective organisation of child disability health services.     

Adsorption of thiocyanate ions to the dodecanol/water interface characterized by UV second harmonic generation

Recent experimental and theoretical results have firmly established the existence of enhanced concentrations of selected ions at the air/water interface. Ion adsorption to aqueous interfaces involving complex organic molecules is relevant to biology in connection with the familiar but incompletely understood Hofmeister effects. Here, we describe resonant UV second harmonic generation (SHG) studies of the strongly chaotropic thiocyanate ion adsorbed to the interface formed by water and a monolayer of dodecanol, wherein the Gibbs free energy of adsorption was determined to be −6.7 ± 1.1 and −6.3 ± 1.8 kJ/mol for sodium and potassium thiocyanate, respectively, coincident with the value determined for thiocyanate at the air/water interface. Interestingly, near 4 M and higher concentrations, the resonant SHG signal increases discontinuously, indicating a structural change in the interfacial region.     

Low Density Lipoprotein Apheresis by Membrane Differential Filtration (Cascade Filtration)

Membrane differential filtration (MDF) is an apheresis technique with which atherogenic lipoproteins can be eliminated from plasma on the basis of particle size. In 52 patients (REMUKAST Study, 1,702 treatments), low density lipoprotein (LDL) cholesterol was decreased by 61%, high density lipoprotein (HDL) cholesterol by 42%, and fibrinogen by 54%. Our own results in 3 patients show decreases of 62%, 31%, and 59%, respectively; lipoprotein (a) (Lp[a]) was reduced by 58%. The elimination of atherogenic lipoproteins was accompanied by a loss of macromolecules (IgM: 55%, IgG: 27%, α₂-macroglobulin: 49%) resulting in improved hemorrheologic parameters. Although HDL is eliminated with each apheresis session, pretreatment concentrations of HDL cholesterol increased by 24% during regular apheresis for 1 year (26 patients, REMUKAST Study). However, preapheresis concentrations of other macroglobulins such as immunoglobulins remained decreased compared to concentrations obtained before the first apheresis session (IgM: 34%, IgG: 23%, and IgA: 16%). We conclude that MDF apheresis is an effective method to lower elevated concentrations of atherogenic lipoproteins. The concomitant loss of other macromolecules transiently improves hemorrheology but demands a close monitoring of immunoglobulin concentrations as a safety parameter.     

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Sports participation can result in three types of dental trauma: fracture, displacement, and avulsion. On-field physical exam and classification of dentoalveolar injury can expedite referral for definitive treatment. Emergency measures to control bleeding and store avulsed teeth can help preserve dental integrity. Physicians can help prevent dental trauma by promoting mouth guard use.     

Recreational and household physical activity at different time points and DNA global methylation

BackgroundDNA methylation patterns are heritable but can change over time and in response to exposures. Lower global DNA methylation, which may result in increased genomic and chromosomal instability, has been associated with increased cancer risk. Physical activity is a modifiable factor that has been inversely related to the risk of cancer. Changes in DNA methylation may be a mechanism by which lifestyle and environment factors influence disease. We investigated the relationship between DNA methylation and physical activity in a sample of women enroled in The Sister Study, a large United States (U.S.) cohort study of women aged 35–74 years with a family history of breast cancer.MethodsGlobal DNA methylation was measured using bisulphite-converted DNA and pyrosequencing of a LINE-1 repetitive sequence in the peripheral blood of 647 non-Hispanic white women. Physical activity (average hours per week) was retrospectively assessed for three time periods: childhood (ages 5–12), teenage years (ages 13–19) and the previous 12 months.FindingsCompared with women with physical activity levels below the median for all three time periods, those at or above the median physical activity for one (β = 0.20, 95% confidence interval (CI): ?0.10, 0.49), two (β = 0.22, 95% CI: ?0.08, 0.52) or all three (β = 0.33, 95% CI: 0.01, 0.66) time periods had increased global methylation.InterpretationMaintaining higher levels of physical activity over these three time periods was associated with increased global DNA methylation, consistent with reported associations between exercise and decreased cancer risk.     

Developing Effective Hospice Staff Support Groups: Pilot Test of an Innovative Training Program

Although hospice staff support groups are frequently cited as a valuable resource in coping with hospice work stress, few guidelines exist for implementing a successful group experience. This article summarizes a pilot study of a 12-week audiotape staff support group training program for hospice and oncology workers developed collaboratively by the author and the UCLA California Self-Help Center. Two West Coast hospice groups participated in the study. Group members reported a high degree of satisfaction with the tape program and their group experience. Burnout scores were not significantly affected by the group experience. Preliminary data on coping strategies, implications for the development and strengthening social support networks in the hospice, and suggestions for future research efforts are discussed.